非结核分枝杆菌：2005 年至 2008 年上海的药敏模式和流行率。

Nontuberculous mycobacteria: susceptibility pattern and prevalence rate in Shanghai from 2005 to 2008.

机构信息

Key Laboratory of Mycobacteria Tuberculosis, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai 200433, China.

出版信息

Chin Med J (Engl). 2010 Jan 20;123(2):184-7.

PMID:20137367

Abstract

BACKGROUND

An increasing incidence of disease caused by nontuberculous mycobacteria (NTM) is being reported. The purpose of this study was to determine the isolation rates of NTM from various clinical specimens, and their antimicrobial susceptibility patterns, over a 4-year period in Shanghai.

METHODS

All NTM isolated between 2005 and 2008 at Shanghai Pulmonary Hospital, a key laboratory of mycobacteria tuberculosis in Shanghai, China, were identified with conventional biochemical tests and 16S rRNA gene sequencing. Antimicrobial susceptibility for all NTM was determined using the BACTEC MGIT 960 system.

RESULTS

A total of 21,221 specimens were cultured, of which 4868 (22.94%) grew acid fast bacilli (AFB), and 248 (5.09%) of the AFB were NTM. The prevalence rate of NTM was determined as 4.26%, 4.70%, 4.96% and 6.38% among mycobacteria culture positive samples in years 2005, 2006, 2007 and 2008 respectively. These data indicated that the prevalence rate has continuously increased. Sixteen different species of NTM were identified, the most commonly encountered NTM in Shanghai were M. chelonae (26.7%), followed by M. fortuitum (15.4%), M. kansasii (14.2%), M. avium-intracellulare complex (13.1%) and M. terrae (6.9%). The rare species identified were M. marinum, M. gastri, M. triviale, M. ulcerans, M. smegmatis, M. phlci, M. gordonae, M. szulgai, M. simiae, M. scrofulaceum and M. xenopi. The five most commonly identified NTM species showed high drug resistance to general anti-tuberculosis drugs, particularly, M. chelonae and M. fortuitum appear to be multi-drug resistance.

CONCLUSIONS

The prevalence of NTM in Shanghai showed a tendency to increase over the course of the study. The five most commonly isolated NTM species showed high drug resistance to first line anti-tuberculosis drugs.

摘要

背景

非结核分枝杆菌（NTM）引起的疾病发病率不断上升。本研究的目的是确定上海某结核病重点实验室（上海肺科医院） 4 年来从各种临床标本中分离 NTM 的分离率及其抗菌药物敏感性模式。

方法

采用常规生化试验和 16S rRNA 基因测序对 2005 年至 2008 年期间从上海肺科医院分离的所有 NTM 进行鉴定。采用 BACTEC MGIT 960 系统测定所有 NTM 的抗菌药物敏感性。

结果

共培养了 21221 个标本，其中 4868 个（22.94%）生长出抗酸杆菌（AFB），248 个（5.09%） AFB 为 NTM。2005 年、2006 年、2007 年和 2008 年分枝杆菌培养阳性样本中 NTM 的患病率分别为 4.26%、4.70%、4.96%和 6.38%。这些数据表明患病率持续上升。共鉴定出 16 种不同的 NTM，上海最常见的 NTM 为龟分枝杆菌（26.7%），其次为脓肿分枝杆菌（15.4%）、堪萨斯分枝杆菌（14.2%）、鸟分枝杆菌复合群（13.1%）和偶然分枝杆菌（6.9%）。鉴定出的稀有菌种有海分枝杆菌、胃分枝杆菌、短棒状分枝杆菌、溃疡分枝杆菌、耻垢分枝杆菌、胞内分枝杆菌、戈登分枝杆菌、杉本分枝杆菌、猿猴分枝杆菌、脓肿分枝杆菌、溃疡分枝杆菌、海分枝杆菌。五种最常见的分离 NTM 对一般抗结核药物表现出高度耐药性，特别是龟分枝杆菌和脓肿分枝杆菌似乎为多药耐药。